Overview of thoracic spine (upper back) pain

Briggs, 2009Graf, 2014Johansson, 2016Roquelaure, 2014van Kleef, 2010

Pain experienced in the thoracic spine or upper back is common, with a one-year prevalence of 20% in adults. Higher rates are reported in adolescents, but this may reflect the focus of studies on this group.

Thoracic spine pain is defined as pain localised below the neck and above the costal margin. The thoracic spine is a complex structure with 7 joints (1 intervertebral joint, 2 zygapophyseal or facet joints, 2 costovertebral joints, 2 costotransverse joints) at each of 12 levels. Pain experienced in the thoracic spine can originate from the joints or other structures of the thoracic spine (eg the dura, intervertebral discs, vertebral bodies, muscles, thoracic nerves), or the underlying mediastinal viscera.

Pain experienced in the thoracic spine may also be due to a nonspecific local musculoskeletal condition or serious underlying pathology (eg myocardial ischaemia, pulmonary embolism, vertebral fracture). Thoracic spine pain often coexists with neck pain and low back pain and is common after motor vehicle collisions. Other thoracic spine diagnoses associated with pain include diffuse idiopathic skeletal hyperostosis and Scheuermann disease.

The prognostic factors for thoracic spine pain have not been well studied, although occupational factors, age and mental health appear to be important.